If you're trying to figure out your chances of having a C-section, look in
your wallet. If you have a health insurance card, research shows that you're
more likely to deliver by cesarean than a woman who's uninsured or

Rita Rubin

If you're trying to figure out your chances of having a C-section, look in
your wallet. If you have a health insurance card, research shows that you're
more likely to deliver by cesarean than a woman who's uninsured or covered
by Medicaid, the state/federal program for low-income Americans. And your
driver's license yields more information than all those diplomas hanging in
your obstetrician's office -- that is, if you were honest about your age and
weight when you applied for your license!
If you were over your ideal weight before you conceived, or you gained more
than 40 pounds while pregnant, you're more likely to deliver by cesarean.
Those extra pounds raise your risk of developing diabetes or high blood
pressure, which in turn increases your chance of having a C-section.

Even if
you avoid those complications, it's important to remember that the more
weight you gain, the bigger your baby might be -- and bigger babies tend to
be harder to push out. Studies by researchers at the National Institutes of
Health and elsewhere also suggest that the heavier you are, the longer your
labor might be.

And even if you're a rail, simply being closer to your 40th than your 30th
birthday raises your chance of delivering by cesarean, especially if it's
your first baby. If you're one of those so-called "mature" pregnant women
(don't you love those terms?) preparing to deliver your first baby, you're
in good company.

Growing numbers of women who delayed childbearing because
of graduate school, career advancement, infertility or late and second
marriages are now tossing hair dye along with diapers into their shopping
carts. Just look at these numbers from the National Center for Health
Statistics, part of the federal Centers for Disease Control and Prevention:

In 2002, birth rates for women age 35 to 39 and age 40 to 44 were the
highest in more than 30 years -- 41 births per 1,000 women and 8 per 1,000
women, respectively.

From 1990 to 2002, the number of babies born to women age 40 to 44 nearly
doubled -- from 48,607 to 95,788.
The birth rate for women age 45 to 49 has been stable since 2000, but the
actual number of births to women in this age group more than quadrupled
between 1984 and 2002. That's because there are more of these women --
thanks to the baby boomer bulge -- and they're more likely to give birth,
partly because of infertility treatments.

The majority of pregnant women over 35, or even over 40, deliver healthy
babies. But there's no getting around the fact that the older you are, the
more likely you are to deliver your baby by C-section. For example, Harvard
researchers found that 43 percent of first-time mothers age 40 and older who
delivered at Boston's Brigham and Women's Hospital in 1998 had cesareans,
compared to only 12 percent of those under 35. One reason for that disparity
is pretty simple: The older you get, the more likely you are to experience
pregnancy complications that predispose you to a cesarean. They include:

Multiples (often a result of infertility treatments)

Breech babies

Illnesses such as diabetes and high blood pressure

But even if you don't have any of the above risk factors, you should be
aware that simply being a first-time mother who's at least 35 years old
increases your chance of having a C-section. Part of that may be
physiological; part of it may be cultural.

A San Francisco study of 8,500
first-time moms who delivered full-term, head-down babies found that the
older they were, the longer they labored. Their cervixes dilated more
slowly, and it took longer for them to push their babies out. Not
surprisingly, then, the older they were, the more likely they were to
receive oxytocin (frequently referred to by one of its brand names, Pitocin)
to ramp up their labor. But it's not like your uterus suddenly heads south
when you hit 35. Here's a cheery thought: The study found that the chance
that your uterus has lost its "oomph" actually begins to increase when you're
in your early 20s -- long before you begin to entertain thoughts of Botox or
bifocals.

Even if you're as healthy as a horse and your uterus is chugging along just
fine, your age might still mean the difference between a C-section and a
vaginal delivery. Perhaps you've spent many years and many thousands of
dollars in your quest for motherhood. It's understandable that you -- and
your doctor -- might be a little more anxious about your baby's safety than
if you were 10 or 15 years younger. This condition has been dubbed "precious
baby" or "premium baby" syndrome, and it can lead to a lower threshold for
performing C-sections.

In other words, if there's even the slightest
suggestion that your baby is in trouble during labor, your doctor would
resort to a cesarean faster than with a younger patient who could easily get
pregnant again. You might find this line of thinking perfectly logical, or
you might not. But however you feel about it, you should discuss your
feelings with your doctor well in advance of your due date. No matter what
your age, remember that you're not destined to have your labor stall or your
doctor choose a C-section without your knowledge or consent.